Genito-Pelvic Pain/Penetration Disorder
DSM-IV In DSM-IV, this is a category called Sexual Pain Disorders Disorders # Dyspareunia (Not Due to a General Medical Condition) # Vaginismus (Not Due to a General Medical Condition) DSM-5 Diagnostic Criteria A'''. Persistent or recurrent difficulties with one (or more) of the following: # Vaginal penetration during intercourse. # Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts. # Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration. # Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. '''B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C'''. The symptoms in Criterion A cause clinically significant distress in the individual. '''D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of a severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: * Lifelong: The disturbance has been present since the individual became sexually active. * Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: * Mild: Evidence of mild distress over the symptoms in Criterion A. * Moderate: Evidence of moderate distress over the symptoms in Criterion A. * Severe: Evidence of severe or extreme distress over the symptoms in Criterion A. Differential Diagnosis Another medical condition In many instances, women with genito-pelvic pain/penetration disorder will also be diagnosed with another medical condition (e.g., lichen sclerosus, endometriosis, pelvic inflammatory disease, vulvovaginal atrophy). In some cases, treating the medical condition may alleviate the genito-pelvic pain/penetration disorder. Much of the time, this is not the case. There are no reliable tools or diagnostic methods to allow clinicians to know whether the medical condition or genito-pelvic pain/penetration disorder is primary. Often, the associated medical conditions are difficult to diagnose and treat. For example, the increased incidence of postmenopausal pain during intercourse may sometimes be attributable to vaginal dryness or vulvovaginal atrophy associated with declining estrogen levels. The relationship, however, between vulvovaginal atrophy/dryness, estrogen, and pain is not well understood. Somatic symptom and related disorders Some women with genito-pelvic pain/penetration disorder may also be diagnosable with somatic symptom disorder. Since both genito-pelvic pain/penetration disorder and the somatic symptom and related disorders are new diagnoses, it is not yet clear whether they can be reliably differentiated. Some women diagnosed with genito-pelvic pain/penetration disorder will also be diagnosed with a specific phobia. Inadequate sexual stimuli It is important that the clinician, in considering differential diagnoses, assess the adequacy of sexual stimuli within the woman's sexual experience. Sexual situations in which there is inadequate foreplay or arousal may lead to difficulties in penetration, pain, or avoidance. Erectile dysfunction or premature ejaculation in the male partner may result in difficulties with penetration. These conditions should be carefully assessed. In some situations, a diagnosis of genito-pelvic pain/penetration disorder may not be appropriate.